It’s been a while since an update, mostly because the situation on the ground hasn’t changed much. I have received a number of inquiries about re-opening and scheduling though, so it’s a good time to consider how to do this. First off, Vermont Health Department recommendations are still that we remain closed. Specifically: “The Agency of Human Services (AHS) today clarified that the Phase 1 of reopening the healthcare sector includes elective procedures in an outpatient settings only. Acupuncturists, chiropractors, physical therapists, dentists, and many others must remain closed until sector-specific guidance is available. AHS has advised that these businesses should not assume reopening can occur after May 15th and emphasized that Phase 2 guidance for reopening these businesses will be forthcoming.”

That’s the legal part. I am thinking the earliest I might be up and running is June, and still not sure. The medical part is a rather long discussion, but to simplify it, our greatest risk of exposure to the virus has to do with the time spent in an area in which transmission could occur. Although every step can be taken to reduce the risk of transmission, the time it takes to have a treatment is not short which underlies my abundant caution in proceeding. Vermont, in general, though is doing GREAT! Anyway, I will repeat what I said in my first post: “I would suggest that going into any “uncontrolled” environment should be avoided by most of us in the near future, and only when necessary. That is what is behind all the shutdowns. In between uncontrolled and completely sterile environments are what I would call “controlled” environments, and we are doing our very best to make this office one of those, not a locus or vector for spreading illness.”

At this point, it’s probably worth reviewing my first post for the hygienic details of how I hope to achieve this. Since then, I have decided on several additional actions to help. I will be using disposable non-woven sheets for each person—these are similar to mask material. And we will all be wearing masks. Appointments will be staggered so that a minimum of 30 minutes is allowed between room occupancy, during which time I will use an ozone generator to disinfect the air. You will know which room to go to when you arrive, and not wait in the waiting room—just proceed to the restroom, wash hands thoroughly and go to your assigned room. Please bring a bag for your clothes and put your outerwear in it immediately, and then you will be in your acuwear for the session! This will keep the outside outside as much as possible. We will need to complete scheduling and such either in the room, or via email, etc. For payment, I would prefer to limit using credit cards, but they of course can be cleaned, and checks can be put in a box for days (I rarely go to the bank more than twice a month anyway) but all that being said, it’s a great idea to learn how to use Venmo. It’s a free way to do bank transfers with two layers of separation. I am obviously going to have a reduced number of visits a day, most likely limited to 4-5 at most. I am also, as of today, still contemplating how much time I want to leave between both individual visits and morning/afternoon sessions to maximize air cleaning. All of this is so we can all feel as safe as possible. So, scheduling will be fairly inflexible timewise unfortunately. A third variable that I am extremely frustrated by is the ridiculously slow development of guidelines in general, and testing guidelines in particular. Just last week (and Vermont is doing well with this) the Health Department issued guidelines saying that anyone who had mild symptoms, or was exposed to someone sick for some length of time could be authorized to get a test. (Testing and tracing) Meanwhile, in the State of Washington, they are still working on developing appropriate guidelines for the cadence of testing essential personnel. I have called and written the Governor’s office and Health Department several times with no response trying to find out if any plans to do so here are even in the works. Any provider, such as myself, a dentist, a PT, etc. who is working in close proximity to people for even a shorter length of time than we work together should be regularly tested to rule out asymptomatic transmission. Truly, this does upset me greatly, as it was probably my first thought in early March even before sequestering. Maybe anyone who reads this can send an email to Governor Scott? Currently, the plans on reopening safely revolve around assessing any uptick in cases and hospitalizations, not assessing possible spread through random testing. This will leave a 2-3 week lag time at least. I know I’m not supposed to be a policy guy, but this is just common sense being ignored. Anyway, check back later in the month to see about scheduling—I will have picked available days and times by then!

March 23. The clinic is now closed for in person treatment. I will be working to establish protocols for either telephone or computer based consultations in the near future. Many of my herbal suppliers are currently back ordered as manufacturers in California are on shut down.

March 24. I will be available for consultations by phone, email, and perhaps zoom (but I’m no Pro!). It is not too likely I will work from the office more than a couple of slots/week, but can easily swing by to retrieve formulas (when they are available of course!) if you’re ill. Also, it is not hard to refill constitutional formulas with some notice, and quite safe for me to leave herbs outside at my home, but not at the office. For consultations (other than refills), I will charge $120/hour, with a $25 minimum, and use a timer to be fair. This will hold for email exchanges as well. Therefore, it is best to collect your thoughts, write them out and send them along. It is also fine to talk–it just will take more time. As you know, I am inclined to deliberate in order to get things right. A good idea is to practice taking selfies of your tongue! If you are concerned about illness, please check your temperature at rest. Also, concerning illness, it is probably best to communicate visually with Facetime, Zoom, etc. as a lot is revealed by observation. Payment wise, I encourage folks to use Venmo, which is free for everyone concerned. I wish there was a way to do pulses at a distance! OK, thanks!

March 25. Governor Scott issued a shelter in place order today which holds till April 15th. Stay sane and safe! And retrieving and formulas you may need is an essential activity for sure. As above, this will mostly be conducted from my side porch!

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This is a difficult juncture for us all, and it is important that we all do our personal best to remain healthy, and to reduce the health risk to others. It is also clear that until there is adequate and easily accessible testing for the virus we will remain somewhat in the dark, and even then gaps in knowledge about who is ill will remain. It does not make sense to opt for paralysis however, rather for an abundance of educated caution. To add more clarity to that, I would suggest that going into any “uncontrolled” environment should be avoided by most of us in the near future, and only when necessary. That is what is behind all the shutdowns. In between uncontrolled and completely sterile environments are what I would call “controlled” environments, and we are doing our very best to make this office one of those, not a locus or vector for spreading illness. The most up to date studies show that the virus can linger in aerosol form for up to three hours, can remain on solid surfaces for up to three days, and porous ones for up to 24 hours (like cardboard, cloth, etc.) Given the 5-14 day latency period, we cannot count on people not being infected and contagious even when they are appearing well. So, it should be apparent that no environment can be guaranteed to be sterile, although we can do our best to be as hygienic as possible. Essentially, here we are doing everything we can to practice vigilant hygiene, short of sterilization. Clean linens for each client, and handwashing between contact with all people and devices, much like one would expect in a medical clinic. Every day we are cleaning doorknobs, light switches, sink faucets, toilet flushers, arms of chairs, hard surfaces, glass, pens, etc. with Clorox wipes and/or alcohol. We have added touchless soap dispensers–and please use paper towels to be disposed of in foot operated bins. There is a hospital grade HEPA/UV filter running all day, and each night when the office is empty it runs a sanitizing ozone session for several hours. All clients are asked to wash their hands upon entering the office, and we have the capability of taking your temperature on the forehead should there be any concern of fever. If you are sick and possibly infectious, we ask you to please not come into the office, with no charge for last minute cancellations. It is in all of our best interests not to bring any infectious condition, cold, flu, or otherwise into this space. Obviously, some details might be a little hard to discern during allergy season (it’s already starting) for sneezing, but everyone should know their own history. Fever and dry cough are absolutely distinguishing variables. I will be using disposable non-woven sheets for each person—these are similar to mask material. And we will all be wearing masks. Appointments will be staggered so that a minimum of 30 minutes is allowed between room occupancy, during which time I will use an ozone generator to disinfect the air. You will know which room to go to when you arrive, and not wait in the waiting room—just proceed to the restroom, wash hands thoroughly and go to your assigned room. Please bring a bag for your clothes and put your outerwear in it immediately, and then you will be in your acuwear for the session! This will keep the outside outside as much as possible. We will need to complete scheduling and such either in the room, or via email, etc. For payment, I would prefer to limit using credit cards, but they of course can be cleaned, and checks can be put in a box for days (I rarely go to the bank more than twice a month anyway) but all that being said, it’s a great idea to learn how to use Venmo. It’s a free way to do bank transfers with two layers of separation. Please fill out all sections of the check in advance and I will do the total for you (to limit pen sharing). I am obviously going to have a reduced number of visits a day, most likely limited to 4-5 at most, at least in the next several months.

I would suggest that it is most prudent for anyone who is either vulnerable, lives with or is in regular contact with someone who is vulnerable to sequester themselves as the CDC and other health organizations have suggested. To be more specific, the vulnerable include those in poor health, those taking immunosuppressant drugs (prednisone, etc.) the elderly, those with chronic lung and/or heart conditions, etc. Likely, this is a conversation folks have already had, but please check if you’re unsure. Healthwise, the more vulnerable should shield themselves from even common infections, because in the case they contract covid-19, it will be all the more difficult to fight off easily. I recommend that those with a history of lung disorders do use a prophylactic herbal regimen, at least until warm weather reaches us.

So far, the uptick in cases hasn’t appeared, but from what we know the infection lasts 10-14 days, and then four consecutive negative tests one day apart each will confirm recovery. That means a minimum of 3 weeks. It is quite possible that with exposure, any of us may have to suspend practice for two weeks to be safe and up to one month if sick. And that is only once testing is widely available–this is the current reality, and we should do our best to avoid that!

Our plan is to stay healthy, be proactive, and do whatever we can to support the health and well-being of our clients. There are options in the herbal pharmacopeia that can help to prevent and/or slow the onset of the illness, and if contracted, make for a more complete and thorough resolution.

Wellness plans for all should include enough sleep, good food and water, avoidance of excess alcohol, sugar, and regular exercise outdoors if possible. I am available to do herbal consultation if you are ill, but not in person! Also, I am not able to mail or deliver packages, unless you have no available alternative options such as friends, family, or neighbors. I should add that the herbal treatment for this disorder is not uniform. It depends on the phase of illness, the extent of your fever, your age, your medical history and your other complicating symptoms. But that is something that Chinese herbal medicine excels at, so do not shy away from taking advantage of our deep history of managing the progression of and recovery from illness.

If you are concerned about monitoring your health at home, here is some advice. Get a good thermometer and measure your temperature morning and evening for 2-3 days. Consider this your baseline. Average is 97.5, give or take. More than 2 degrees up is cause for concern. Also, for those concerned about their lung health, buy an inexpensive pulse oximeter (you can get one for about $30!). If your oxygenation is below 95%, you may have some cause for concern, but once again, get it soon, and learn your baseline. Below 92% is reason for hospitalization. The old standard was 90, but that’s been updated. These are the exact symptoms which matter for either avoiding and/or seeking treatment for the severe version of the illness.

Here is a little more on the illness itself to consider should you fall ill. You may think of there being 4 courses it can take: mild, moderate, severe, and pneumonia. Any individual may experience only one, or possibly several of these versions, and at different phases. For example, one individual may go through the entire illness in a “moderate” fashion, while another goes straight from mild to pneumonia. That is why vigilance about your condition should you fall ill is so important.

I feel that the information coming from China is very detailed and valuable about the course and treatment of this virus right now, and as with every other aspect of this epidemic our health system is a little behind the curve.

As you can see, “mild” is not so mild, and moderate is like a pretty bad flu.

In addition, it seems that variants have been reported than start as a “cold” and then progress, so any upper respiratory illness should be treated with respect and caution until it clears.

Some non-TCM advice from the Naturopathic world includes the following suggestions for supplements in preventative mode:

Vitamin C: 3,000 milligrams (or more) daily, in divided doses. (Might be too much for some folk’s tummies—try only 1000)

Vitamin D3: 2,000 IU daily. (Start with 5,000 IU/day for two weeks, then reduce to 2,000)

Magnesium: 400 mg daily (in citrate, malate, glycinate)

Zinc: 20 mg daily

Selenium: 100 mcg (micrograms) daily

In addition, if you are in fact ill, I (and now everyone else) would recommend using acetaminophen as preferred fever and pain relief. This is because NSAIDS may reduce your immune response slightly. If you are taking NSAIDS for another medical condition, do not stop them, but do be careful about using your fever as a guideline as it will be thrown off by them. You may add 100-200 mg of Co-Q10/day as it may help get more oxygen to your cells. Reduce food intake, and increase water, electrolytes and simple sugars/carbs. A shortcut is something like Powerade- or make a healthier version. Consider getting a tub of some healthy exercise formula, which is some blend of carbs/protein/electrolytes. I personally recommend a blend of Orgain (available at Costco and online) and Ribose powder, but there are many forms. Emergen-C is good stuff for electrolytes, if you can get it! However, honestly, in a pinch when you’re ill, Powerade is fine, as are any of the exercise gel packs (Clif, etc.) for carbs and electrolytes. That’s all for now, and check back for updates!